- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.56 / $922.85 / $1,281.70
| Professional | | $747.56 | $922.85 | $1,281.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.31 / $1,175.83 / $1,979.13
| Professional | | $723.31 | $1,175.83 | $1,979.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.26 / $883.40 / $1,078.00
| Professional | | $466.26 | $883.40 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.62 / $724.93 / $1,240.78
| Professional | | $108.62 | $724.93 | $1,240.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.55 / $1,071.69 / $1,890.38
| Professional | | $752.55 | $1,071.69 | $1,890.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.35 / $758.57 / $758.57
| Professional | | $616.35 | $758.57 | $758.57 |